Category: Ageing

Categories : Ageing Neurodegenerative DiseasesTags :

Obesity Adds to Alzheimer Severity

On By ModernMedia

In addition to it being a risk factor for many known chronic diseases, obesity is an additional burden on cerebral health and may also be associated with the progression of Alzheimer’s disease, according to a new study from the University of Sheffield and the University of Eastern Finland.  

The study used multimodal neural imaging and showed that obesity may contribute to the vulnerability of neural tissue, while maintaining a healthy weight helped to maintain brain structure in mid dementia Alzheimer’s disease.

Alzheimer’s disease is a neurodegenerative disease which accounts for two thirds of dementia in over 65s, is the sixth leading cause of death in the United States and there is no cure at present.  

Lead author Professor Annalena Venneri from the University of Sheffield’s Neuroscience Institute and NIHR Sheffield Biomedical Research Centre, said: “More than 50 million people are thought to be living with Alzheimer’s disease and despite decades of ground breaking studies and a huge global research effort we still don’t have a cure for this cruel disease.

“Prevention plays such an important role in the fight against the disease. It is important to stress this study does not show that obesity causes Alzheimer’s, but what it does show is that being overweight is an additional burden on brain health and it may exacerbate the disease.”

She added that it was important to educate people early on in their lives as it was too late to wait until the 60s to lose weight as the disease lurks in the backgrounds.

The researchers examined MRI scans of the brains of 47 patients diagnosed with mild Alzheimer’s disease dementia, 68 patients with mild cognitive impairment, and 57 individuals who were cognitively healthy. Using three complementary, computational techniques, they studied the brain’s anatomy, blood flow and also the brain’s fibres.

They compared gray matter volume, white matter integrity, cerebral blood flow and obesity. Grey matter volume decreases in Alzheimer’s. In patients with mild Alzheimer’s, an association was found with obesity and grey matter volume around the right temporoparietal junction, suggesting obesity creates a neural vulnerability in cognitively impaired patients. The study also found that maintaining a healthy weight may help preserve brain structure in structure in the presence of age and disease-related weight loss.

Joint author Dr Matteo De Marco from the University of Sheffield’s Neuroscience Institute, said: “Weight-loss is commonly one of the first symptoms in the early stages of Alzheimer’s disease as people forget to eat or begin to snack on easy-to-grab foods like biscuits or crisps, in place of more nutritional meals.

“We found that maintaining a healthy weight could help preserve brain structure in people who are already experiencing mild Alzheimer’s disease dementia. Unlike other diseases such as cardiovascular disease or diabetes, people don’t often think about the importance of nutrition in relation to neurological conditions, but these findings show it can help to preserve brain structure.”

Source: Medical Xpress

Journal information: Manmohi D. Dake et al, Obesity and Brain Vulnerability in Normal and Abnormal Aging: A Multimodal MRI Study, Journal of Alzheimer’s Disease Reports (2021). DOI: 10.3233/ADR-200267

Categories : Ageing Cardiovascular DiseaseTags :

New Study Has Good and Bad News on TIAs

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There is both good and news on transient ischaemic attacks (TIAs) from a more than six-decade long study: TIAs are indeed harbingers of strokes, but also the incidence of post-TIA strokes has been falling over the decades.

A TIA is defined as a passing episode of neurologic dysfunction due to the focal brain, spinal cord, or retinal ischaemia, without acute infarction or tissue injury. The results were derived from the Framingham Heart Study had 14 059 participants and ran for over six decades, allowing for a more-complete picture of strokes that happen after a TIA. Of the participants, 435 had a TIA; these were compared against a second group of 2175 participants who did not have a TIA.

Even after accounting for other risk factors such as hypertension or diabetes, people who had experienced a TIA had a 4.5 to five times greater chance of a stroke. Study lead author Vasileios-Arsenios Lioutas, MD, said that the results show a need for intensive follow-up of TIA : “According to our findings, people continue to have a high risk of stroke for a sustained time after they’ve had a TIA. Therefore, one shouldn’t think that the high-risk period is just in the first 90 days after the attack and then one can relax. It seems these patients should be followed closely over time, keeping in mind that they are at risk for stroke and paying close attention to controlling their cardiovascular risk factors.”

The 66 years of study data was broken into three epochs. One- and five-year risks of post-TIA stroke in the 2000-2017 epoch were 7.6% and 16.1%, compared to 23.9% and 35.5% during the earliest epoch, from 1948 to 1985.

Sudha Seshadri, MD, professor of neurology at The University of Texas Health Science Center at San Antonio, said: “We examined 66 years of follow-up from Framingham participants, which allowed us to study trends over time. We can see that starting in the very early years of the Framingham study, the 1950s, moving on to the most recent times, the risk of subsequent stroke went down a lot.”

Source: News-Medical.Net

Journal information: Lioutas, V-A., et al. (2021) Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke. JAMA.doi.org/10.1001/jama.2020.25071.

Categories : AgeingTags :

For Older IBD Patients, Vedolizumab is a Safer Option

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Vedolizumab appeared to be safer than tumour necrosis factor (TNF) inhibitors in older adults with inflammatory bowel disease (IBD), according to the results of a large retrospective study.

Vedolizumab is a fully humanised monoclonal antibody which targets α4β7 integrin, and prevents leukocyte movement from the blood into inflamed gut tissue.

At the virtual Crohn’s and Colitis Congress, Bharati Kochar, MD, of Massachusetts General Hospital in Boston, presented data showing that all-cause hospitalisation during the 12 months after initiating biologic treatment was lower in new users of vedolizumab than in those starting TNF inhibitors, with a hazard ratio of 0.81 (95% CI 0.68-0.96)

“The American population is rapidly aging, and the number of Americans 65 and older in 2060 will be more than double what it was in 2014,” Dr Kochar said. “The combination of increasing IBD incidence, improvements in disease treatment-related knowledge, and decreasing IBD mortality is resulting in a high prevalence of older adults with IBD,” she added.

It is estimated that a quarter of Americans over 65 have IBD, yet are less likely to receive adequate immunosuppression. Over 65s are underrepresented in IBD clinical trials, creating a lack of understanding over what medications work or not in this age group.

To answer this question, Dr Kochar and her team analysed a 20% sample of Medicare claims database. Patients were included if they were diagnosed with Crohn’s disease or ulcerative colitis and if they initiated treatment with vedolizumab, infliximab, adalimumab, golimumab, or certolizumab from 2014 to 2018 after being on Medicare for 12 months while not receiving any of those medications.

There were 488 new users of vedolizumab and 2213 initiators of TNF inhibitors in the analysis group, with an average age of 71. More than half were women and most were white, 44% had ulcerative colitis and over half of patients had Carlson Comorbidity Index scores of 2 or higher.

There was otherwise no significant difference between vedolizumab and TNF for IBD-related hospitalisation (HR 0.77, 95% Ci 0.53-1.12), IBD-related surgery: (HR 0.78, 95% CI 0.49-1.22), or new steroid prescription within 60 days of starting the biologic (HR 1.01, 95% CI 0.86-1.18).

In the 6-month period prior to biologic initiation, nearly one-third had a prescription for budesonide, 58% had a prescription for a systemic corticosteroid, and nearly one-third were being prescribed immunomodulators.

“In conclusion, I think it’s important to use your clinical judgment to treat the patient in front of you, and these data should simply help contextualise risk for older IBD patients newly initiating vedolizumab or TNF inhibitors,” said Dr Kochar.

“There is a vast need for additional large and robust comparative effectiveness and safety studies for older adults with IBD, with the rapid proliferation of new IBD medications,” she concluded.

Source: MedPage Today

Presentation information: Kochar B, et al “Comparative effectiveness and safety of vedolizumab and anti-tumor necrosis factor agents in older adults with inflammatory bowel diseases in Medicare administrative claims database” CCC 2021

Categories : Ageing CancerTags :

Aspirin Protects against Colorectal Cancer

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Aspirin is known to reduce the risk of colorectal cancer in middle-aged adults and up until age 70, but has some risky side effects, such as colorectal bleeding. 

It was not known at what stage it was still worth it to start taking aspirin. Indeed, the recent Aspirin in Reducing Events in the Elderly (ASPREE) trial reported that participants taking a daily dose of aspirin (100mg) after the age of 70 for five years had a 30% increased risk of cancer mortality.
It is also currently recommended by the US Preventive Services Task Force that people aged 50-59 years with specific cardiovascular risk profiles take aspirin for its protective effect against heart disease.

To answer the question of whether aspirin was beneficial or harmful after age 70, Andrew T Chan MD, MPH, a gastroenterologist and chief of the Clinical and Translational Epidemiology Unit at Massachusetts General Hospital (MGH), led a team of researchers that analysed a pair of large cohort studies.These were The Nurses’ Health Study (January 1980 – June 2014) and the Health Professionals Follow-up Study (January 1986 – January 2014), giving them a total of 94 500 participants over 35 years.

Their findings showed that aspirin could indeed protect adults over 70 from colorectal cancer – with the caveat that the protection only applied if they started taking aspirin before the age of 70.”There is considerable evidence that aspirin can prevent colorectal cancer in adults between 50 and 70 years old,” commented Chan. “But it has not been clear whether the effect is similar in older adults.”

The researchers concluded that their results “strongly suggest that there is a potential biological difference in the effect of aspirin at older ages which requires further research.”

Source: News-Medical.Net

Categories : Ageing Neurodegenerative DiseasesTags :

Parkinson’s Disease Spotted in Advance with Health Checkup

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A study by the University of Nagoya has shown that general health checkups may be effective at spotting early signs of Parkinson’s disease (PD) in advance.

Specifically, the prodromal stage shows sex differences, with the markers for males being decreased cholesterol and haematocrit (the percentage of red blood cells in blood) levels, while in females it is increased blood pressure. PD is the second most common disease affecting the nervous system after Alzheimer’s disease, is caused by a deficiency in the neurotransmitter dopamine. By the stage where sufferers experience motor symptoms such as tremors, stiffness, bradykinesia (slowness of movement), more than half of all dopaminergic neurons have been lost. Postural instability occurs in the late stage. Several processes have been implicated in PD, such as mitochondrial dysfunction, defective protein clearance mechanisms, and neuroinflammation, but it is not clear how these factors interact.

Prior studies have shown that non-motor symptoms including constipation, rapid eye movement sleep behaviour disorder, impairment of sense of smell, and depression, emerge in patients with PD 10 to 20 years before the onset of motor symptoms – meaning that PD may be detectable in advance with other measures.

“If we can detect biological changes in the patients’ bodies well before the onset of the motor symptoms, we can start medical treatments in an early stage,” said Prof Masahisa Katsuno of the Graduate School of Medicine at Nagoya University.

The team used health checkup data from 22 male and 23 female patients with PD, dating to before they were diagnosed with the disease. They supplemented this with data from 60 male and 60 female healthy individuals who had checkup data for at least four years.The checkup data was compared between healthy individuals and PD patients to establish a baseline, and then were examined for longitudinal changes prior to the onset of PD. They found that in the premotor stage, blood pressure increased in females, while in males total and low-density cholesterol levels and haematocrit decreased.

“In this study, we found that blood pressure, haematocrit, and serum cholesterol levels are potential biomarkers of Parkinson’s disease before the onset of its motor symptoms,” said Prof Katsuno. “This finding indicates that general health checkups can help detect early signs of developing Parkinson’s disease.”  Based on the findings, the team is now working to identify individuals at risk of developing PD in an attempt to forestall the development of their disease.

Source: Medical Xpress

Journal information: Katsunori Yokoi et al. Longitudinal analysis of premotor anthropometric and serological markers of Parkinson’s disease, Scientific Reports (2020). DOI: 10.1038/s41598-020-77415-1

Categories : Ageing Diet and Nutrition Mental HealthTags :

Mediterranean-type Diets Protect Against Parkinson’s Disease

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Researchers at the University of British Columbia have shown that the Mediterranean diet and another diet based on it, have a strong link in protecting against Parkinson’s disease (PD). 

These two diets had previously been shown that they could protect against other neurodegenerative diseases. The Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet combines aspects of the Mediterranean diet and the DASH diet which protects against hypertension. The MIND diet emphasises consumption of berries, as research shows that they protect against mental decline, eating leafy greens and poultry. The MIND diet also mostly does away with potato, milk and fruit (excluding berries).

Senior author Dr Silke Appel-Cresswell said, “There is a lack of medications to prevent or delay Parkinson’s disease yet we are optimistic that this new evidence suggests nutrition could potentially delay onset of the disease.”
Following the diets delayed the average onset of PD by 17.4 years in women, and 8.4 years in men.

Since PD already has a notable sex difference, with 60% of sufferers being men, despite their shorter average lifespan, the sex difference in response to the diets opens new avenues of research
“It drives home the connection between the gut and the brain for this disease,” Dr Brett Finlay said. “It also shows it’s not just one disease that healthy eating can affect, but several of these cognitive diseases.”

Source: Medical Xpress

Journal information: Avril Metcalfe‐Roach et al, MIND and Mediterranean Diets Associated with Later Onset of Parkinson’s Disease, Movement Disorders (2021). DOI: 10.1002/mds.28464

Categories : Ageing ExerciseTags :

Mid-life Exercise Positively Shapes Late-life Brain Structure

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That exercise in one’s middle years benefits health in later life is perhaps no surprise given our current understanding of its benefits, but and MRI study has shown to influence the brain’s structure in later years.

Using MRI scans, high levels (150 minutes per week or more) of self-reported moderate-to-high physical activity were associated with reduced risk of lacunar infarct in late life (OR 0.68, 95% CI 0.46-0.99) and more intact white matter integrity.

“Our study suggests that getting at least an hour and 15 minutes of moderate-to-vigorous intensity physical activity a week or more during midlife may be important throughout your lifetime for promoting brain health and preserving the actual structure of your brain,” said Priya Palta, PhD, of Columbia University Irving Medical Center. “In particular, engaging in more than 2 and a half hours of physical activity per week in middle age was associated with fewer signs of brain disease.”

There has been mixed evidence linking physical activity to brain measures or improvements in cognitive function. PhDs Nicole Spartano, of Boston University School of Medicine, and Leonardo Pantoni, MD, of University of Milan, noted in an accompanying editorial that the “most consistent evidence for the protective effect of physical activity against dementia risk has been reported to be leisure time physical activity, and it is unclear whether there is benefit to other types of physical activity that may be less ‘enriching.'”

“It is possible that future work will uncover the requirement that physical activity interventions to reduce dementia risk actually have an enriching element, such as in leisure-time activities, rather than be strictly rote, mechanical movement,” Spartano and Pantoni added.

Recruiting 1 604 individuals with a mean baseline age of 54, the participants had five examinations over 25 years and MRI at a mean age of 72. At baseline (1987-1989) and 25 years later, participants had their moderate-to-vigorous physical activity assessed in a questionnaire. 

At midlife, 11% had low levels of moderate-to-high intensity activity (1 to 74 minutes a week), 16% middle levels (75 to 149 minutes a week), and 39% high levels (150 minutes a week or more), with the remainder reporting none.

High moderate-to-vigorous midlife activity was associated with better white matter integrity in late life, compared with no moderate-to-vigorous midlife activity, but there was no association with grey matter volume.

While the risk of lacunar infarcts were lower with more intense midlife activity, risk of cortical infarcts or subcortical microhemorrhage were not. “The associations of greater levels of mid-life physical activity with fewer lacunar (but not cortical) infarcts and greater white matter microstructural integrity suggest cerebrovascular mechanisms are primarily at play,” Palta and colleagues wrote.

When adjusted for vascular risk factors, the association of midlife physical activity to lacunar infarcts was weakened, but the association with white matter microstructure. The editorialists said that it implies that “evidence from this study supports a hypothesis that the mechanisms linking physical activity and the brain are likely multi-dimensional, including mechanisms other than simply improving cerebrovascular health.” 

Late-life moderate-to-vigorous physical activity also was associated with most brain measures compared with no moderate-to-vigorous activity, but as this was a prospective study that spanned decades, the “association between midlife physical activity levels and later-life brain imaging features makes a much stronger case for causality than does the same relationship when measured only in late life,” the researchers noted.

The study had several limitations, which included using self-reported data, did not include non leisure-related activity, and participant attrition.

Source: MedPage Today

Journal information: Source Reference: Palta P, et al. A prospective analysis of leisure-time physical activity in midlife and beyond and brain damage on MRI in older adults, Neurology 2020; DOI: 10.1212/WNL.0000000000011375.

Categories : Ageing Pain ManagementTags :

New Drug Relieves Rheumatoid Arthritis Pain

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A new drug, otilimab, has shown effectiveness in treating rheumatoid arthritis (RA). Otilimab is a human monoclonal antibody which inhibits granulocyte-macrophage colony-stimulating factor (GM-CSF). GM-CSF is a large driver of immune-mediated inflammatory conditions.

The drug is currently being tested on its ability to suppress inflammation, tissue damage and pain in RA sufferers.

A multicentre, dose-ranging trial conducted with the drug. Participants were administered subcutaneous injections with one of five different dosages of otilimab (22.5 mg, 45 mg, 90 mg, 135 mg, or 180 mg) or placebo weekly for five weeks. Thereafter, they received injections once every two weeks for one year. The results showed a rapid reduction in tenderness and swelling, and a very high reduction in pain.

The study was unusual in that it offered an escape arm. It is often difficult to recruit participants when they know they may be receiving a dummy injection, and so if, after 12 weeks the participants  on the placebo arm derived no benefit, they were transferred to the highest dose arm of 180mg.

Source: Medical Xpress

Journal information: Christopher D Buckley et al, Efficacy, patient-reported outcomes, and safety of the anti-granulocyte macrophage colony-stimulating factor antibody otilimab (GSK3196165) in patients with rheumatoid arthritis: a randomised, phase 2b, dose-ranging study, The Lancet Rheumatology (2020). DOI: 10.1016/S2665-9913(20)30229-0

Categories : Ageing ExerciseTags :

Standing Protects against Heart Failure in Older Women

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A study examining elderly women’s amount of time spent sitting or standing has shown a marked increase in the risk for hospitalisation for heart failure.

The Women’s Health Initiative Observational Study followed 81 000 postmenopausal women for 9 years. None of the women had been diagnosed with heart failure and could walk at least one block unassisted, and they self-reported the amount of time they spent sitting or lying down. Over this time, 1402 women were hospitalised with heart failure.

The researchers graded the amount of sedentary time (sitting or lying down) into three categories: 6.5 hours or less; 6.6-9.5 hours; and more than 9.5 hours. Those who sat 9.5 hours or more experienced a 42% increase in the rate of heart failure compared to those who sat for 6.5 hours or less.

Lead author of the study,  Michael J LaMonte, PhD, MPH, research associate professor of epidemiology in the School of Public Health and Health Professions at the University at Buffalo in Buffalo, New York, said that there was a lack of data on sedentary time and heart failure, and even less so in elderly women.

“Our message is simple: sit less and move more. Historically, we have emphasised promoting a physically active lifestyle for heart health—and we should continue to do so! However, our study clearly shows that we also need to increase efforts to reduce daily sedentary time and encourage adults to frequently interrupt their sedentary time.” 

He added, “This does not necessarily require an extended bout of physical activity; it might simply be standing up for 5 minutes or standing and moving one’s feet in place. We do not have sufficient evidence on the best approach to recommend for interrupting sedentary time. However, accumulating data suggest that habitual activities such as steps taken during household and other activities of daily living are an important aspect of cardiovascular disease prevention and healthy aging.”

Source: Medical Xpress

Categories : Ageing GeneticsTags :

Hyperbaric Oxygen Shown to Increase Telomere Length

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In a world first, the length of human telomeres in living subjects has been increased in a prospective clinical trial as part of a broader study of aging. This was accomplished with the use of hyperbaric oxygen therapy (HBOT).

Telomeres place a limit on the number of times cells can be replicated, shortening by 20-40 bases every year and are thought to be one of the causes of aging as shorter telomeres are related to greater vulnerability to disease. Telomere length reduction can be slowed with diet and exercise, but not increased.

The trial recruited 35 participants aged over 63, who did not undergo diet or lifestyle changes. Each patient received 60 HBOT sessions over 90 days. The telomere length of T and B cells significantly increased by over 20%. B cells showed the greatest lengthening at 36.7% post-HBOT.

“After dedicating our HBOT research to exploring its impact on the areas of brain functionality and age related cognitive decline, we have now uncovered for the first time in humans HBOT’s biological effects at the cellular level in healthy aging adults,” said Prof Shai Efrati of the Faculty of Medicine and Sagol School of Neuroscience at Tel Aviv University. “Since telomere shortening is considered the ‘Holy Grail’ of the biology of aging, many pharmacological and environmental interventions are being extensively explored in the hopes of enabling telomere elongation. The significant improvement of telomere length shown during and after these unique HBOT protocols provides the scientific community with a new foundation of understanding that aging can, indeed, be targeted and reversed at the basic cellular-biological level.”

Source: The Sagol Center for Hyperbaric Medicine and Research via PRNewswire